ESPAnet Conference 2012

Stream 10 “Balancing the needs of users, paid and unpaid carers”

Kirstein Rummery and Teppo Kröger

Birgit Pfau-Effinger

“Family care regimes” – the institutional framework of family care in European welfare states

First Draft

Prof. Dr. Birgit Pfau-Effinger

Institute for Sociology

Director, Centre for Globalisation and Governance

University of Hamburg

Allende-Platz 1, 20146 Hamburg, Germany

Introduction

Since the 1990s, many European welfare states have extended social rights and social services in the field of long-term senior care. At the same time, they have strengthened economic principles in the field of care, which means that there was a new emphasis on ‘choice’, the role of the market in the provision of elderly care, and on efficiency as a new main welfare value. In the context of these changes, the ways in which welfare states are framing the situation of care recipients and of family carers, as well as their relationship, have also substantially changed. The figure of the old person in need of care, who was interpreted before these changes as the client/patient, has been replaced by the figure of a ‘consumer’ making ‘free choices’. In most countries the frail elderly can choose between offers by different providers of home care who compete on the care market, and care performed within the family.

Family care in the second half of the 20th Century was usually unpaid, informal and done by (mostly female) spouses or adult children of the frail elderly people. Welfare state researchers have criticized this type of care, since it overstretches the resources of the family and contributed to women’s exclusion from the labour market and gender inequality (England, 2005; Kröger & Sipilä, 2005). Since the later 1990s, welfare state policies towards family care have substantially changed. Many welfare states started to support family members in their caring role. The unpaid care by relatives has been substantially transformed into forms of family care paid for by state programs such as the ‘long-term care insurance’, ‘cash-for-care’ programs or specific programs by municipalities. The ways in which welfare states institutionally frame the care work by family members and their relationship with the care recipients differs substantially in a cross-national perspective.

Analysis of the change generally concentrates on tendencies of the relocation of care work out of the private household, where it was traditionally mostly carried out by women on an informal and unpaid basis, and its transformation into formal, paid and sometimes professionally performed gainful employment. The question of which policies support or impede this change has also been investigated (AnttonenSipilä 2005; Knijn & Verhagen, 2007; Pavolini & Ranci, 2011). In comparison, less attention has been given to changes that informal care work in the family household itself has experienced. This is often equated with traditional “housework”, which was tied historically to the housewife role of the married women and constituted a fundamental basis for the exclusion of women from gainful employment (e.g. Leira 2002). In actual fact, welfare state reforms have also led to new forms in which institutions are framing family care, and created new, semi-formalized or fully formalized forms of family care (Pfau-Effinger, 2005).

The aim of this paper is to introduce the approach of the “family care regimes” as a theoretical framework for cross-national analyses of welfare state institutions which are framing the work situation of family carers and their relationship with the care recipients in family care. It also distinguishes two different new types of the family care regime.It then shows that these two types also differ regarding the degree to which they are connected with tensions regarding the work situation of family carers as a consequence of marketization. The focus of the paper is restricted to welfare state institutions and how these are framing care work in the family. It therefore does not include analysesof the concrete forms of family care itself.

In a first part, the paper shows how welfare state reforms in European welfare states in the field of long-term care for senior citizens have changed the ways in which welfare state institutions are framing family care. The next part analyses the state of the art regarding comparative analyses of how welfare state institutions are framing family care. It shows that a typology of the institutional settings that are framing family care is missing so far. It then introduces the concept of ‘family care regimes’ and distinguishes two different new types of the family care regime. Moreover, it discusses how these potentially produce tensions in relation to the care work of family carers. The paper ends with the conclusions.

Change in the institutional framework for family care in European welfare states

In the last two decades, many European welfare states have extended social rights related to public provision in the field of senior care, as a consequence of the ageing of society. On the other hand they have also extended social rights for caring family members. Until the 1990s, most European welfare states had treated care for senior citizens mainly as a task of female family members. These were expected to provide informal and unpaid family care on the basis of the principle of family solidarity in the framework of a male breadwinner family. The task of the welfare state in the field of long-term care for senior citizens was often restricted to providing residential care of very frail older people. It was expected that the subsistence of the female, unpaid family carer was guaranteed in the context of the male breadwinner family. Only very affluent seniors in need of care were able to buy home care on care markets on which for-profit care agencies competed.In the new care policies of many welfare states, long-term care for elderly people as far as it is provided by their relatives is no longer informal, unpaid and hidden in the family context. Instead, welfare states have introduced new forms of family care which are semi-formal or formal, paid and connected with elements of social security in the context of welfare state programs(Geissler & Pfau-Effinger, 2005).

This restructuring of welfare provisions has overlapped with another major change in care policies of European welfare states, which is the marketization of long-term care for senior citizens. This means that many welfare states have introduced regulation principles which are based on market logic in those institutions which are framing care for senior citizens where it previously was absent or weak (Bode, 2007; Pavolini & Ranci, 2008; Vabø, 2006). In this context, care policies construct elderly people in need of care as ‘consumers’, who ‘buy’ the care that they need on markets, with support through public funding. Such markets are characterized by a competition between different providers, and different types of providers. The ‘choice’ that the elderly have between different providers of care includes the choice of a family member, who takes over the care. In the new types of care policies, caring family members often are eligible for pay for their care. In the new settings of institutions that are framing elderly care by caring family members therefore market principles interact with different other regulation principles.These include the principle of family solidarity in the context of the male breadwinner family, and the principle of social rights. Such institutional settings in part are framing the family care in rather contradictory ways and are thus connected with tensions (Pfau-Effinger & Rostgaard, 2011; Jensen & Møberg, 2011).

State of the art of analyses of welfare state institutions framing family care

Thus far, little research exists about the changes in the ways in which welfare state institutions are framing family care and how the care work of the family carer is legally constructed in different welfare states. Admittedly, some research has analysed the way in which welfare states are influencing and conditioning family care. But in most cases family care giving is not treated as work that one could compare with other types of work, like work in formal employment. This is somewhat surprising, since it is for example a traditional paradigm in feminist theorizing about care, that ‘care’ is a specific type of work (c.f. Daly & Lewis, 2001).

Some scholars consider family care as detrimental for women. According to their argument, the formalisation of family care by welfare states is an emancipatory project that ‘frees’ women from the duty to care for their own relatives. The focus is on the de-familialising and re-familialising role of different types of welfare state policies, in which case the re-familialising usually is treated as something negative that should be avoided (Esping-Andersen, 1999; Leitner, 2003). In this literature it is most often neglected that family care itself has changed and has in part more formal features.

Some researchers have analysed the legal framing of family care more in detail. However, they restricted this in part to a specific instrument that some welfare states used in this context, and the comparative perspective is more on the use of this instrument in different welfare states than on the ways in which different institutions of the welfare state are framing the care work of family members. For example da Roit & Le Bihan (2011) investigated the situation of women in cash-for-care programmes for long-term elderly care in France and Italy. They were particularly interested in the ways these programmes shape informal care and family relations in these countries. They analysed the situation of family caregivers, mainly women, who combined employment and long-term care of an elderly family member, and found that cash-for-care systems, differently from what is sometimes expected, do not in principle support a re-familisation of care in these countries. Instead, people use them for outsourcing long-term care. The main perspective of their study however – different from that of our article – was on the work-family balance of caring women, and less on the legal framework of family care. Ungerson (2004) analyses the ways the ‘commodification of care’ has developed in European countries. Her main focus is on the pay that caring family members receive, and on how it is paid. According to the findings, these payments often have the character of what she calls ‘routed wages’. This term relates to ‘the method whereby people in need of care are given cash rather than (or in addition to) formal care services, and then encouraged to employ their own care labour directly with this cash’ (Ungerson, 2005:49).

The results of the above-mentioned studies show that long-term care provided by family members no longer fits the description of informal work. Often it is paid in the context of welfare-state programs, and includes elements of social security. Pfau-Effinger (2005) has introduced the term ‘semi-formal care’ for such kinds of family care. There was some recent research of the author of this paper with co-authors about comparative policy analyses of the legal framework of paid family care, how it constructs the work situation of those who provide care for old relatives, and their relationship with the elderly ‘care consumer’ (Pfau-Effinger, Jensen & Och, 2011). However, a typology of the institutional settings which are framing family care is missing so far.

The concept and the typology of ‘family care regimes

In this part I introduce the concept of family care regimes and different types of the family care regime. The concept of the ‘family care regime’ characterizes the specific settings of institutions of the welfare state that are framing the work situation of those who provide care for an older family member and the care relationship between care giver and care receiver. This concept treats ‘family care’ systematically as a specific form of work, which has the features of informal, semi-formal or of formal work. By ‘family members’ I mean persons who belong by definition broadly to the same family as the persons in need of care, such as daughters and sons, spouses or partners.

The paper also distinguishes different types of family care regimes on the basis of the main regulation principles on which they are based. Common regulation principles in this context include mainly also the role of the principle of family solidarity on the basis of the male breadwinner marriage, the role of regulation framing standard employment, and the role of social rights connected with family care for the care provider. In this regard the paper identifies two new types of the family care regime.These types differ in relation to the main regulation principles on which the institutional framework for family care is based, and how these principles interact. The paper distinguishes between a semi-formal family care regime and the formal family care regime. Both are ideal types according to the definition of Max Weber (1963), which means that the typology overemphasizes the systematic differences between the different types, whereas the concrete family care regimes in specific welfare statesmay be somewhat less coherent.

The semi-formal and the formal type are similar, in that the eligibility of frail older persons to care often is based on a combination of market principles and social rights principles. The welfare state institutions framing long-term care for senior citizens usually construct old people who are in need of care as ‘consumers’ who have free choice on care markets and who get publicly provided or publicly funded care provision. Frail old people have the option to decide between different types of care by agencies, and between care by agencies and family care, and to get finances in order to be able to pay for the type of care which they choose. This also means that people in need of care have the option to be ‘freed’ from personal dependence in the family, since family members compete with other types of providers on ‘care markets’.

If the care recipient chooses a family member as main care provider in the semi-formal family care regime, he or she acts as contractor and ‘quasi-employer’ vis-à-vis the caring family member. In this case, the family care has the character of ‘semi-formal care’ (Pfau-Effinger, 2005). This means that the caring family member has the right to receive some pay for her/his family care work, but this pay is not based on standards of formalized standard employment and minimum income legislation. It is clearly lower and is fixed on the basis of benefits and social rights, not on the basis of employment rights. It is even possible that it is means tested.The benefits are either paid by public institutions directly to the family carer, or else they are paid by public institutions to the care recipient who is expected to forward the public benefits that he receives to the person who gives the care. The family carer may also have some social rights to social security, like rights to pay contributions to the pension insurance, but these also do not match the standards of social security in formal standard employment. In general, the semi-formal family care regime is based on the expectation that usually women act as family carers, and that their subsistence and social security is at least in part financed by the income of a male breadwinner.

This means, that different regulation principles interact in the semi-formal family care regime in the perspective of the caring family member. These include the principles of employment rights and social rights which play a role to a limited degree, and the principle of family solidarity in the context of the male breadwinner marriage, which also is of some importance. The German welfare state with its care policies represents such semi-formal care regime (Pfau-Effinger, Jensen & Och, 2011).

Table 1: Different new types of family care regimes

Main types of the family care regimes
Main regulation principles / Type 1:
Semi-formal family care regime / Type 2:
Formalised family care regime
Role of family solidarity on basis of male bread-winner family
Role of social rights principle
Role of employment rights / medium
medium
medium / weak
strong
strong
Country examples / Germany / Denmark

Also in the formal family care regime, the care recipient may be institutionally constructed as ‘care consumer’ who receives public pay for the care and can choose between different types of care providers. The person in need of care is also free to choose a family member as carer, besides other options. However, the institutional framing of the work situation of the caring family member is different than in the semi-formal family care regime.